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CANCER

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FALL 2016

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Coordinated care, possibility of cure page 8 Navigating through a diagnosis page 10 Three predictors of lung cancer survival page 12 Can you get a feeding tube and a port at the same time? page 14 Advice for coping with mouth sores page 15

Brought to you by the


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YOURGUIDE GUIDE YOUR

What to expect at your first visit UPSTATE CANCER CENTER staff members begin preparing for a patient’s first visit as soon as the appointment is scheduled. They request radiology and laboratory results and other information from your referring physician, so cancer specialists can review those reports before you arrive. For your first consultation, please allow at least 1½ hours. You will meet with a cancer doctor and other members of your treatment team to discuss your options and determine the recommended course of treatment. Patients may be referred or request a second opinion.

How to make an appointment:

How to prepare:

Call the Upstate Cancer Center at 315-464-4673 to schedule a consultation.

• Research the type of cancer with which you have been diagnosed before your appointment, because being informed can help you make choices about your treatment options. Our website at upstate.edu/cancer includes resources in the “Cancer Types” tab. • Learn about your physician by typing his or her last name into the “Find a Doctor” section of the main upstate.edu website.

PHOTO BY SUSAN KAHN

What to bring with you: • A completed medical history form (available at upstate.edu/cancer); • A list of the medications you currently take, including over-the-counter medications; • Health insurance card;

• Write down any questions and bring them with you.

• Employer’s name, address and phone number, if you are covered under your employer’s insurance plan;

• Invite a family member or friend to accompany you to help listen and take notes during your appointment.

• Advance directives, or “living will,” if you have one;

• Let the appointment scheduling staff know if you need translation services or interpretation for the hearing impaired.

Bogart

Bratslavsky

Damron

Gajra

Gentile

• Your referring physician’s name, address and phone number; • Parking ticket for validation.

Kittur

Krishnamurthy

Lemke

Seth

Patients love these doctors Every year the Upstate Foundation celebrates National Doctor’s Day in March by collecting tributes from grateful patients and families — and hand-delivering messages of gratitude to the physicians. Among the Upstate physicians receiving the highest number of tributes over the past five years are nine who specialize in some form of cancer. Radiation oncologist Jeffrey Bogart, MD

Medical oncologist Teresa Gentile, MD, PhD

Urologic oncologist Gennady Bratslavsky, MD

Liver and pancreas surgeon Dilip Kittur, MD

Orthopedic oncologist Timothy Damron, MD

Neurosurgeon Satish Krishnamurthy, MD

Medical oncologist Ajeet Gajra, MD

Medical oncologist Sheila Lemke, MD Medical oncologist Rahul Seth, DO

ARE YOU GRATEFUL? You can honor your physician and other caregivers by making a donation to the Upstate Cancer Center. For details, contact the Upstate Foundation at 315-464-4416 or www.FoundationForUpstate.org

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INSIDE

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Inside this issue SEARCHING FOR CURES

SHARING EXPERTISE

The Cancer Center’s next phase

page 4

Research involves cell division, orthopedics, brain metastases, more

page 5

CARING FOR PATIENTS What to expect at your first visit

page 2

Breast cancer survivor promotes screening

page 6

She got a personal plan from her cancer team

page 8 page 10 back cover

care

CAN

page 12

Ports and feeding tubes can be installed at same time

page 14

Managing mouth sores

page 15

A look at progress with pediatric cancers

page 16

IMPROVING LIFE

How patient navigation works A quick way to diagnose a suspicious lump

Do existing medical problems impact lung cancer?

ER

A soup that’s easy on the mouth and tummy

page 18

Where to find advice for eating right

page 18

Art from adversity

page 19

On the cover: Gail Brehm has a pancreatic cancer team. See story, page 8. PHOTO BY ROBERT MESCAVAGE

for anyone touched by cancer

FALL 2016

CANCER CARE

UPSTATE CANCER CENTER

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications

DIRECTOR (INTERIM) Jeffrey Bogart, MD

Amber Smith 315-464-4822 or smithamb@upstate.edu

MANAGING EDITOR

WRITERS DESIGNER

Leah Caldwell, Lily Grenis, Jim Howe, Amber Smith Susan Keeter

The Upstate Cancer Center provides the quarterly magazine Cancer Care for anyone touched by cancer. Send subscription requests and suggestions to magazine@upstate.edu and request additional copies by calling 315-464-4836. Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.

DEPUTY DIRECTOR (INTERIM) Gennady Bratslavsky, MD ASSOCIATE DIRECTOR FOR CLINICAL AFFAIRS Ajeet Gajra, MD ASSOCIATE DIRECTOR FOR CLINICAL RESEARCH Stephen Graziano, MD ASSOCIATE DIRECTOR FOR BASIC AND TRANSLATIONAL RESEARCH Leszek Kotula, MD, PhD ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH Leslie J. Kohman, MD

The Upstate Cancer Center is part of Upstate Medical University in Syracuse, N.Y., one of 64 institutions that make up the State University of New York, the largest comprehensive university system in the United States. Upstate Medical University is an academic medical center with four colleges, a robust biomedical research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s downtown and community campuses, the Upstate Golisano Children’s Hospital and many outpatient facilities throughout Central New York — in addition to the Upstate Cancer Center. The Cancer Center is located at 750 E. Adams St., Syracuse, NY 13210.

ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA

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SEARCHING FOR CURES

Leszek Kotula, MD, PhD, in his lab. He is one of Upstate’s researchers who seeks to benefit cancer patients with advancements in diagnostic and treatment options.

PHOTO BY WILLIAM MUELLER

Leaders focus on Cancer Center’s new phase UPSTATE CANCER CENTER OFFICIALS are improving outcomes for cancer patients by integrating the medical care, research, education and outreach programs that are already in place. “We have outstanding research faculty, outstanding clinicians and some of the best cancer-fighting technology around, as well as spirited community outreach efforts. These all work to win the war against cancer for our patients,” says Jeffrey Bogart, MD, interim director of the cancer center. “When we align all that Upstate does in the field of cancer care, we intensify our institutional might in battling this disease.” The institution has a long history of providing collaborative multidisciplinary care with integrated cancer clinics dating back to the 1990s. Bogart says the depth and breadth of subspecialty expertise at Upstate is unmatched in the region and unique in the number of fellowshiptrained doctors specializing in cancer. The new structure of the cancer center facilitates a team-based approach organized around specific tumor sites, including breast cancer, lung cancer, genitourinary malignancies, head and neck cancer, neurologic cancers and cancers of the liver, pancreas and gallbladder, among others. Upstate also houses the only children’s cancer treatment facility in the region. In his role as interim director, Bogart, who also serves as chair of radiation oncology, oversees all cancer care and cancer-related research at Upstate.

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He says a stronger alignment between the cancer center and the academic institution will “strengthen our cancer care, accelerate scientific discovery, bolster our academic programs and extend our community outreach and education efforts far beyond our campus.” Bogart adds that this new structure puts the cancer center in the best position to grow and respond to the changing market and health care reform dynamics. It will also set in motion Upstate’s long-term strategy of earning a National Cancer Institute designation. NCI-designated centers are recognized for their scientific leadership, resources and the depth and breadth of their research in basic, clinical and population science. “This is an important designation that reflects on an institution’s integrated approach to cancer care,” Bogart says. Assisting Bogart is the newly created Cancer Center Leadership Committee which includes broad representation from campus, including department chairs, nursing, research and hospital leadership. Gennady Bratslavsky, MD, professor and chair of the urology department, is vice chair. Other key appointments include Leszek Kotula, MD, PhD, associate professor of urology and biochemistry and molecular biology, for basic and translational research; Ajeet Gajra, MD, associate professor of medicine, for clinical affairs; Stephen Graziano, MD, professor of medicine, for clinical research; and Leslie Kohman, MD, SUNY Distinguished Professor of Surgery, for community outreach.●

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SEARCHING FOR CURES

Timothy Damron, MD Kenneth Mann, PhD

Dimitra Bourboulia, PhD

Wenyi Feng, PhD

Heidi Hehnly, PhD

Juntao Luo, PhD

Vivian Gahtan, MD

What might $50,000 help discover? BY AMBER SMITH

SCIENTISTS THINK BIG, and long term. They measure progress incrementally, knowing that solutions are often years, decades, centuries in the making. Such dedication can bring society closer to finding cures for cancer, ways to prevent the disease or extend survival. To that end, the Carol M. Baldwin Breast Cancer Research Fund of CNY awarded grants of $50,000 each to five research projects at Upstate that just might help find:

A WAY TO IDENTIFY FRACTURE RISKS Breast cancer patients whose disease spreads to bone are at risk for disabling fractures. If there were a reliable method of predicting which bones were most likely to break, surgery could be done to reduce the risk. Orthopedic surgery professors Timothy Damron, MD, and Kenneth Mann, PhD, are testing a way of identifying fracture risks using computerized tomography and a structural stress analysis. The Baldwin grant money will allow them to further verify the sensitivity and specificity of this method.

A MEANS OF STEMMING THE SPREAD OF BREAST CANCER Breast cancer becomes deadly when it spreads, so some researchers are focused on impeding tumor cell migration. Assistant professor of urology Dimitra Bourboulia, PhD, explains that tumor cells migrate once a group of enzymes called matrix metalloproteinases degrade structural protein barriers. She’s looking at natural inhibitors to these enzymes, hoping to understand their impact on tumor cell invasion — and come up with a new treatment strategy for metastatic breast cancer.

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A ROUTE TO TARGETED THERAPY Most human cancers evolve from genetic mutations that occur due to gene damage during a person’s life. One form of damage is chromosomal DNA strand breakage, which cancer cells exploit to rearrange the genome and adopt abnormal behaviors. Wenyi Feng, PhD, assistant professor of biochemistry and molecular biology, maps chromosome breaks in breast cancer cell lines using a novel technology called Break-seq. If proven sensitive enough, the technique could ultimately be used to help doctors prescribe targeted therapy.

A DEEPER UNDERSTANDING OF CELL DIVISION Heidi Hehnly, PhD, an assistant professor of cell and developmental biology, studies mitotic cell division, in which a cell splits into two genetically identical “daughter” cells. This process relies heavily on an enzyme to segregate the chromosomes into the two cells. Defects in this process lead to the progression of cancers. Hehnly’s lab is working to understand exactly how.

A SAFER WAY TO DELIVER MEDICATION Not all medications have the ability to cross into the brain from the bloodstream, but a cancer drug called cabazitaxel does. It was developed for use when other drugs stop working, so it holds promise for treating cancers and brain metastases, such as breast cancer that has spread to the brain. The problem is, the drug harms other organs with which it comes into contact. That’s why Juntao Luo, PhD, an assistant professor of pharmacology, and Vivian Gahtan, MD, the division chief of vascular surgery and endovascular services, will study whether a nanocarrier delivery system developed in their lab can safely transport cabazitaxel into the brain to treat breast cancer brain metastases, while sparing healthy tissue. ●

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Breast cancer survivor preaches screenings BY JIM HOWE

JANET BACON’S BREAST CANCER is rare in one way, but typical in another: It shows the importance of early detection. Bacon, 59, of Syracuse, had skipped her annual mammogram in 2014 — she had let a lot of things slide that year after losing her best friend. In 2015, a resident health advocate — someone trained by Upstate to help neighbors find medical information and promote health — called Bacon to ask whether she had gotten that annual mammogram to screen for breast cancer, as part of the She Matters program (see box). “So I went for it,” Bacon says of the mammogram she got in March 2015. “I didn’t think anything of it. They called me back for an ultrasound. About a week later, they said I needed a biopsy. I didn’t think anything of that, either,” she says, noting she had been called back for a biopsy years ago that amounted to nothing. This time was different. “It was cancer. I was devastated. I couldn’t speak at first,” she says. She was diagnosed with ductal carcinoma in situ, found very early at stage zero. This would normally be treated with a lumpectomy — surgical removal of the cancerous tissue, not the whole breast‚ followed by whole-breast radiation to prevent recurrence. An Unusual Case

But Bacon’s case was unusual — so much so that her doctors plan to publish a case study of it. She has scleroderma, a complicated, chronic disease of the connective tissue that has also affected her kidneys. Radiation can cause scarring in people with scleroderma, so that would tend to rule out the usual treatment, says Bacon’s radiation oncologist at Upstate, Anna Shapiro, MD. “It would be a shame for her to have a mastectomy,” says Shapiro, but an operation to remove the entire breast was a likely alternative to avoid the radiation. The multidisciplinary team at the Upstate Cancer Center decided, however, that a lumpectomy could be done if followed by a type of radiation called brachytherapy, which targets an area small enough to minimize the scarring. Bacon’s brachytherapy involved inserting tiny radioactive pieces through a tube into a balloon implanted at the lumpectomy site, twice daily for a week. Brachytherapy is successful for a select group of patients, such as Bacon, who are generally at low risk for recurrence, Shapiro says. continued on page 7 Janet Bacon PHOTO BY SUSAN KEETER

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CARING FOR PATIENTS

Breast cancer survivor

continued from page 6

Part of her team

Bacon feels fortunate not only for the care she received, but for her family, which includes a brother and six sisters living down South, as well as nieces and nephews, who came to lend support. “They ran straight here to me the day I had surgery” in May 2015, she recalls. After the operation, her surgeon, Upstate’s Scott Albert, MD, told her relatives in the waiting room that the operation was a success. “He did a wonderful job,” Bacon says. Radiation treatment followed a month later, and a mammogram in October 2015 showed no trace of cancer. Bacon has wasted no time in recommending regular mammograms to her female relatives, noting the family history of breast cancer includes not just herself but a niece who died of the disease. Bacon says she is doing well, goes to routine check-ups every four months and will take anti-cancer medication for five years. “I think breast cancer is my passion now. I don’t want anyone to go through what I went through.” She says, “the No. 1 thing is getting a mammogram.” She adds she is consistent in reminding her neighbors to get a mammogram.

Surgeon Scott Albert, MD

Radiation oncologist Anna Shapiro, MD

She is now a resident health advocate herself and works to keep her 300 or so neighbors in the Toomey Abbott Towers on Almond Street informed about their health, particularly through She Matters programs. Shapiro echoes the need for mammograms and outreach programs like She Matters. “The reason we’re so successful at improving success in curing breast cancer is because we’re able to diagnose it so early. The success story of breast cancer really lies in early detection. Typically a mammogram picks up something small,” Shapiro says. Albert notes that Bacon’s type of cancer is usually only picked up through a mammogram. ●

HOW TO OBTAIN A MAMMOGRAM The New York State Cancer Services Program offers breast, cervical and prostate cancer screenings to residents who meet income eligibility and age requirements. Call 866-442-2262 for details. In addition, many public health departments (check with the one in the county where you live) provide access to low-cost or no-cost mammography and other cancer screenings for people without health insurance coverage. The Upstate Cancer Center’s “She Matters” program makes mammography available to underserved women living in Syracuse Housing Authority locations in downtown Syracuse. The program includes education and awareness about the disease, as well as general wellness. A recent grant of $25,000 — the latest in an ongoing effort from the Susan G. Komen Foundation’s Central New York affiliate — helps expand this outreach to include Toomey Abbott Towers, Pioneer Homes and Almus Olver Towers.

Janet Bacon and Martha Chavis-Bonner (seated), both of whom are resident health advocates, sign people up for mammograms and colorectal cancer screenings at the Mary Nelson Back to School Barbecue, held in August. PHOTO BY SUSAN KEETER

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She Matters was founded in 2014 and receives support from the housing authority and several community and Upstate organizations and departments. Hear an interview at healthlinkonair.org. Search “She Matters.”

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CARING FOR PATIENTS

Personal plan Her team crafted the best way to fight her pancreatic cancer BY AMBER SMITH

A TUMOR QUIETLY GROWING in Gail Brehm’s pancreas invaded her stomach and surrounding soft tissues. Eventually the mass began pressing on a nerve. Brehm, 63, a retired postal worker in Auburn, felt that pain in her lower left side. She thought she had pulled a muscle. When the pain didn’t get better, her family doctor told her she might have a kidney stone and scheduled an imaging scan. Before she went for that appointment, Brehm says the pain became unbearable. She went to Upstate University Hospital’s emergency department in late October 2015. “I’ll never forget it. The doctor came back in the room and said she had very unexpected results,” Brehm recalls. The scan had revealed a large tumor that appeared to be malignant.

PHOTO BY ROBERT MESCAVAGE

Nurse Holly Briere summarizes how she serves patients with cancers of the liver, pancreas or gallbladder: “I’m somebody they can always count on.” She helps schedule medical appointments, answer questions, and fields requests for any sort of assistance.

Brehm had already survived breast cancer. Treated in 2011, she was found to have inherited a gene mutation linked to breast cancer. It was likely the new tumor was related. She was afraid.

For Brehm’s care, oncologist Muhammad Naqvi, MD, oversaw six rounds of chemotherapy designed to help shrink the tumor. He also prescribed medicine to quell the unrelenting nausea that caused Brehm to rapidly lose 20 pounds.

Ajay Jain, MD, associate chief of liver and pancreatic surgery at Upstate, met with Brehm. Her biopsy revealed cancer, and he wanted to operate.

“After that very first chemotherapy treatment, the pain started to go away,” Brehm recalls. “I knew that tumor was shrinking. I just knew it.”

Her imaging scan, however, suggested that the tumor was very large and invading her stomach and blood vessels that feed other organs.

It was shrinking.

He decided to present her case to a team of doctors, nurses and technicians at Upstate who specialize in cancers of the liver, gallbladder and pancreas. At this weekly meeting, every cancer patient’s case is reviewed individually to come up with a personalized treatment plan. What works for one person may not be the recommended treatment for another. Given the extensive spread of Brehm’s cancer, her team agreed surgery would be feasible only if the tumor could first be reduced. “The goal of surgery is to cut it out and not leave cancer behind,” Jain explains. Chemotherapy, radiation therapy or a combination are sometimes key parts of the strategy. Another key aspect for patients at the Upstate Cancer Center is a nurse navigator. 8

Gail Brehm with her surgeon, Ajay Jain, MD, associate chief of liver and pancreatic surgery. Her coordinated plan showed good results.

CANCER CARE

But not enough for surgery. While Brehm was hospitalized over the Christmas holiday, Jain and his senior partner, Dilip Kittur, MD, chief of liver and pancreatic surgery at Upstate, stopped in to see her and consult on her care. They reviewed new imaging scans. Jain had to disappoint Brehm. “You’re still not ready,” he told her. “The purpose of surgery is to get it all out. If I operate and leave it behind, it’s not going to help.” Brehm’s team recommended additional chemotherapy, with a plan to consider radiation therapy if necessary. Jain ultimately performed surgery in April, six months after Brehm’s diagnosis. He removed the back half of her pancreas, some of her stomach and soft tissue adjacent to the aorta and other major blood vessels supplying the rest of the bowel. continued on page 9 Learn about nurse navigation, page 10. upstate.edu/cancer l fall 2016


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CARING FOR PATIENTS

Personal plan

continued from page 8

The pathology report showed no evidence of active disease, no cancer cells along the borders, or margins, of where the surgeon cut. “That does not mean there’s no risk of the cancer coming back,” Jain explains. “It means she had a very good response to her treatment. Given that she has no tumor at the margins, she has the best chance she could have of reducing her risk of recurrence.”

Dilip Kittur, MD PHOTO BY SUSAN KAHN

Brehm remembers the news she received after her surgery. “They told me the results couldn’t have been better. The tumor was big, and the fact that it hadn’t spread to my liver was just a miracle.” Now the team recommends that Brehm follow up with imaging scans every three months for the next couple of years. She’s also taking a different type of chemotherapy, which Naqvi says has been shown to extend survival. Radiation may be recommended afterward. Brehm is grateful for how well things turned out. She had such a good outcome because of the coordination of the care she received, Jain says. Pancreatic cancer is aggressive. While chemotherapy or radiation alone may have extended Brehm’s life, they would not have offered the possibility of cure. With the carefully orchestrated care plan Brehm’s team crafted for her — measured chemotherapy and precision radiation followed by exacting surgery — she received the best possible chance of remaining cancer free. ●

Gail Brehm with her oncologist, Muhammad Naqvi, MD. PHOTOS BY ROBERT MESCAVAGE

Upstate this fall became one of four institutions in New York and the only one outside of New York City to be designated as a National Pancreas Foundation Center for the treatment and care of patients with pancreatic cancer. The designation, which highlights Upstate’s multidisciplinary treatment of pancreatic cancer and the array of treatment options available, required an extensive audit. To gain the designation, an institution must have expert physician specialists in oncology, gastroenterology, pancreas surgery, clinical trials, palliative care and interventional radiology, plus patient programs including pain management services and psychosocial support. Upstate last March earned the designation of an NPF Center for Care and Treatment of Pancreas Disease. Hear an interview at healthlinkonair.org. Search “Jain.”

PEDIATRIC EMERGENCY DEPARTMENT:

HERE WHEN YOU NEED US Upstate University Hospital has the area’s only Pediatric Emergency Department, now in its own newly renovated and expanded space. Only at Upstate will you find physicians and nurses specially trained in pediatric emergency medicine 24/7/365.

Pediatric Emergency Department C A R I N G F O R PAT I E N T S . S E A RC H I N G F O R C U R E S . SAV I N G L I V E S .

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CARING FOR PATIENTS

Navigating t a cancer

BY AMBER SMITH

While each person’s cancer journey is unique, patients are likely to encounter similar services and treatment options along the way. Holly Briere, a nurse navigator specializing in cancers of the liver, gallbladder and pancreas, guides us through what the experience may entail. The Upstate Cancer Center offers nurse navigators who specialize in various types of cancers.

STEP TWO

Initial referral to a cancer doctor

Meeting the nurse navigator

Creating a personalized care plan

A patient’s primary care doctor may refer him or her to a physician at the Upstate Cancer Center for assistance in diagnosing cancer, or for expert care after a cancer diagnosis. Depending on the situation, the first appointment could be with a medical oncologist, a surgeon or a radiation oncologist.

A nurse navigator becomes the point of contact for patients at the Upstate Cancer Center. The navigator helps coordinate appointments, answer any questions and arrange for services that go beyond standard medical care. “I’m somebody they can always count on,” says Holly Briere.

The patient’s cancer center physician discusses his or her case with a team of doctors, nurses, technicians and other caregivers during weekly multidisciplinary meetings. Each team member can contribute expertise toward the best care plan for the patient, which may include one or more of these therapies, at right.

STEP THREE

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STEP ONE

The hepatobiliary team is one of the multidisciplinary teams at the Upstate Cancer Center. Pictured, from left: Ajoy Roy, MD, gastroenterologist; Savio John, MD, gastroenterologist; Holly Briere, nurse navigator; Steve Landas, MD, pathologist; Nuri Ozden, MD, gastroenterologist; Rahul Seth, DO, medical oncologist; Dilip Kittur, MD, surgeon; Anna Shapiro, MD, radiation oncologist; Ajay Jain, MD, surgeon; Muhammad Naqvi, MD, medical oncologist and Olivia King, nurse practitioner. PHOTO BY SUSAN KAHN

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CARING FOR PATIENTS

through diagnosis STEP FOUR: TREATMENT Other appointments

Chemotherapy refers to any of a variety of medications that are used separately or in combination, in specific dosages and over particular time spans as a method of treating cancer. Sometimes chemotherapy is prescribed as the only treatment. Sometimes it precedes other treatments. It may also be used at the conclusion of primary treatment, to help lower the risk of recurrence.

Nurse navigators can help patients and their loved ones arrange for:

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Medical oncology

Spiritual care Genetic counseling Nutritional advice Assistance from a social worker

Financial counseling and insurance coverage Assistance with legal matters Help conducting library research

Integrative medicine consultations Psychological counseling Support group information Rehabilitation therapy

Fitness counseling Smoking cessation help Fertility counseling Lodging in the Syracuse area during treatment

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Radiation oncology A variety of external beam radiation therapies is available to help shrink tumors before surgery or eliminate microscopic cancer cells after surgery. Today’s advanced radiotherapy machines deliver radiation with unprecedented precision. Brachytherapy is also an option, for tumors that are likely to respond to the temporary placement of tiny radioactive sources.

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Surgery A surgical team may operate to remove a tumor from a patient with cancer. Surgeons are also involved in the installation of ports to ease chemotherapy administration.

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STEP FIVE

Survivorship A patient’s basic health needs change after a cancer diagnosis. The survivor wellness team at Upstate works with existing health care providers to ensure comprehensive communication and a personalized plan for post-treatment life.

Palliative care Depending on the patient’s wishes, a palliative care plan may be crafted to focus on relief from the symptoms and stress of cancer.

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SHARING EXPERTISE

How much do existing medical problems impact lung cancer? BY AMBER SMITH

WHEN PEOPLE ARE DIAGNOSED with lung cancer, they usually ask about survival odds.

physical function and physiologic organ function, that should be part of a full evaluation.

Doctors have used calculation methods that take into account the patient’s other diseases, known as comorbidities.

He shares three better predictors of a lung cancer patient’s survival: whether they are 1.) cigarette smokers, 2.) age 80 or older, or 3.) in poor general health.●

A cancer expert at Upstate suggests those calculations may be outdated. Ajeet Gajra, MD, writes in the Journal of Geriatric Oncology that some diseases have a greater impact than others on the treatment for and survivability of lung cancer.

COMMON ‘COMORBIDITIES’ The vast majority of Americans 65 and older have multiple health issues that could impact lung cancer treatment, including: High blood pressure, 73%

He cites one analysis that compared lung cancer patients who had multiple health problems with those who did not. The two groups of patients survived for similar lengths of time. In another analysis, patients with severe comorbidities reported a poorer health-related quality of life — but their conditions did not deteriorate significantly more than patients with fewer health problems.

Chronic obstructive pulmonary disease, 57%

Considering a patient’s other diseases is important, Gajra says, but due to the complexities of various diseases on

Depression, 21%

Ischemic heart disease, 53% Diabetes, 32% Congestive cardiac failure, 31% Chronic kidney disease, 30%

State health chief taps Upstate doctor for cancer panel LESLIE KOHMAN, MD, director of outreach for the Upstate Cancer Center, was appointed to the New York State Cancer Detection and Education Program Advisory Council. The council has 21 members appointed by state Health Commissioner Howard Zucker, MD, JD, who provide recommendations and guidance on cancer-related prevention and detection issues, disease management and treatment, new technologies and survivorship.

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Kohman points out that New York has a higher incidence of cancer but a lower death rate than the nation as a whole. This indicates good medical care in our state, she says, “however, there are striking differences by county, and these disparities need to be corrected.” Her work with the American Cancer Society and the New York State Cancer Consortium has given Kohman familiarity with the state’s cancer plan. ●

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UPSTA ATE TR AT REAT TS THE E MO OST STR T OK KES IN THE REGION G N

Hesham Masoud, MD, Amar Swarnkar,, MD, and Grahame Gould, MD, in the bi-plane b angiograaphy OR at Up pstate University Hospittal. As part of the intraaoperatiive MRI surgical suite, surg geon ns can obtain scans during procedur o es.

CARING FOR PATIENTS. AT SEARCHING FOR S R CURES. SAVIN V G LIVES.

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SHARING EXPERTISE

Study shows doubling up can make sense – and it’s safe

Pathologist Rana Naous MD, examines a spot in which a fine needle aspiration could be used to test a tumor in the neck for cancer. See the back cover for more PHOTO BY WILLIAM MUELLER on this procedure.

BY AMBER SMITH

MOST PATIENTS WITH HEAD AND NECK CANCER require the installation of a port, and many will also need a feeding tube. “For the patient’s convenience, placing both devices at the same time would be ideal,” says Katsuhiro Kobayashi, MD, an assistant professor of radiology at Upstate who was part of a study that examined whether doing both procedures at once was as safe as doing them several days apart. Interventional radiologists commonly install these devices. Ports help reduce the number of times patients are stuck with needles for blood samples or medication injections. Feeding tubes are necessary for patients who can’t take in enough food by mouth to stay healthy. Kobayashi and Philip Skummer, a second-year medical student at Upstate, reviewed the medical records and imaging studies for 76 men and women treated for head and neck cancer at Upstate between January 2012 and June 2014. The researchers wanted to know if infection rates

were different for the 30 who had a port and a feeding tube installed in two separate sessions than for the 46 who had both devices installed in the same session. None of the patients developed infections with their ports in the first 30 days after they were placed. About 11 percent of patients from the single session group and 7 percent from the two-session group developed minor infections with their feeding tubes within the first 30 days of its placement. Infections are an unfortunate risk of the procedure. The researchers concluded that having both devices installed in the same session did not significantly increase that risk. ●

Katsuhiro Kobayashi, MD

Philip Skummer

Assessing that ‘ounce of prevention’ “THE WAY YOU LIVE YOUR LIFE affects your chances of getting cancer,” Upstate graduate Peter Greenwald, MD, emphasized at the 12th annual Upstate Cancer Symposium in September. Greenwald, the associate director of prevention at the National Cancer Institute, gave a rundown of behaviors that put people at risk. At the top of the list: smoking, whether tobacco, electronic cigarettes or marijuana.

He spoke of vaccines, of how aspirin lowers the risk of colorectal cancers, and of unanswered questions about the threats of environmental cancers. He also addressed diets, and the impossibility of accurately tracking everything an individual eats and drinks over a lifetime in order to study its impact on cancer formation. Greenwald made the point that one who wishes to reap the benefits of a healthy lifestyle later in life needs to set about living a healthy life while still young. ● Peter Greenwald, MD

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PHOTO BY RICHARD WHELSKY

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SHARING EXPERTISE

Coping with mouth sores

BY AMBER SMITH

What they are: Mouth sores that develop during chemotherapy and/or radiation treatment are called “oral mucositis.” They look like burns. Often they appear on the inside lining of the mouth or lips. You may notice them on your gums, tongue, roof or floor of your mouth. They may also appear on the esophagus, the tube your food travels through to reach the stomach. Whether they form depends on the type and dose of chemotherapy you are taking, or the area and dose of radiation delivered if you are taking radiotherapy. How they form: Many cancer treatments are designed to kill rapidly growing cells. Cancer cells grow rapidly, but so do the cells that line the inside of your mouth. When these healthy cells are damaged, mouth sores may develop. This can range from a minor inconvenience to a severe complication that could impede eating, talking, swallowing and even breathing. Why they matter: Untreated, mouth sores can lead to infection, painful ulcers or the inability to eat and drink, and cancer treatment can be affected. How they’re treated: Doctors can prescribe medications that coat the entire lining of the mouth, so the sores are protected and the pain is lessened. Topical painkillers may be used for numbing. What you can do: • Make sure your dentist is aware you will be undergoing chemotherapy or radiation therapy and ask about taking care of any unresolved dental issues, such as gum disease, cavities or teeth that need to be pulled. • Tell your cancer doctor if you have a history of mouth sores. Antiviral medicines are sometimes prescribed for people who get frequent mouth sores from the herpes simplex virus. • Floss with caution. If you have dentures, clean them at least once a day, wear them only when necessary and make sure they fit properly.

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• Rinse your mouth frequently while awake and if you awaken during the night. Use a solution of 12 ounces of warm water, ¼ teaspoon baking soda and ½ teaspoon salt. • Brush your teeth with a soft-bristle brush after every meal, using a nonirritating toothpaste as recommended by your dentist. • Check your mouth three or four times a day for sores or any changes — and keep your doctor posted. • Keep your lips and mouth moist. Drink 1 to 2 liters of fluid per day. Use a lip moisturizer. Suck on sugar-free candy or chew gum. Popsicles or ice can help decrease swelling and reduce pain. Consider using a saliva substitute. • Liquid Tylenol or Advil may help relieve mouth pain. Your doctor or nurse can recommend prescription options if necessary. • Maintain good nutrition, eating foods and liquids that are easy to swallow. Cut your food into small pieces. Or, you may need to use a blender to mix your food with a liquid. • Foods high in protein are the best choice. You may also include daily servings of liquid supplements such as Ensure, Boost or Carnation Instant Breakfast. Seek a referral to a nutritionist if you would like help. What you should not do: • Do not assume you can crush medication if you are having trouble swallowing. Speak to your pharmacist first. • Do not use alcohol-based mouthwashes, which can dry out your mouth. • Do not use alcohol, caffeine and tobacco, as these can cause your mouth to dry out. • Do not eat extremely hot or cold foods or fluids, and avoid foods that are spicy or contain citric acid to avoid mouth irritation. • Do not eat foods that are hard, crunchy or chewy because they can irritate your mouth. ●

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IMPROVING LIVES

A moonshot Pediatric cancer chief explains how the effort could help young patients BY JIM HOWE

OVERALL, ONE COULD SAY the U.S. is doing well in battling childhood cancers. Since the 1960s, pediatric cancer deaths have fallen steadily. Today’s average five-year survival rate is 84 percent, compared to about 50 percent in 1975. But challenges remain, says Melanie Comito, MD, Upstate’s chief of pediatric hematology and oncology. She points out that progress has been slow, or nonexistent, in treating some childhood cancers in the last two decades, resulting in lost lives and devastated families. In addition, of the roughly 80 percent of childhood cancer patients who are alive after five years, about half end up with chronic medical conditions. About a fifth die prematurely. Most of the money for cancer research goes to adult cancers, Comito says, because adults make up about 99 percent of all cancer cases. Of the 1.6 million Americans diagnosed with cancer each year, about 16,000 are younger than 20. While far more adults get cancer, children pay a bigger cost in death or chronic medical conditions, Comito told an audience at an Upstate cancer symposium in September. The average loss of life from cancer is 71 years for children, compared to 15 years for adults, since adults tend to be diagnosed at age 67, and children at age 6. Put another way, 11 U.S. children die of cancer every day, or about 4,000 a year, making it the biggest cause of childhood death from disease. Comito expresses hope as she describes how the “Cancer Moonshot” — the ambitious national effort underway to defeat the disease — could help young cancer patients: l

repurposing drugs now used only for adults.

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developing drugs targeted to children’s cancers and aiming to lessen later effects.

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adapting immunotherapy — using the patient’s immune system — for children’s cancers.

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studying the microenvironment, or healthy tissue around tumors, to better target the disease.

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increasing research funding.

CANCER CARE

Melanie Comito, MD, Upstate’s chief of pediatric hematology and oncology. PHOTO BY SUSAN KAHN

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continuing and improving the multidisciplinary approach to treatment, to pool the knowledge of researchers and health care providers.

What if a cure meant not only getting rid of cancer but that no one could ever tell you had been treated for it? Comito muses. Or if children could be screened for cancer, then given a biologic agent of some sort, so no one ever needed treatment? “We not only want to cure more children, but we want a cure that will last into adulthood and make them productive adults,” she says. ●

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IMPROVING SEARCHING FORLIVES CURES

Images from the the documentary “Cancer: The Emperor of All Maladies.”

Upstate med student had a hand in PBS cancer documentary BY JIM HOWE

WHEN RAGHIB SIDDIQUI was in his junior year of studying neurosciences and English at SUNY Stony Brook University on Long Island, he looked for work that would nurture his twin interests of science and writing. He came across an internship opportunity he describes as “an interesting confluence of the two.” His background in biology and his college writing samples helped get him hired. His job was to research and tell the complete story of cancer, from prehistory to the present, and make it easily understandable to the crew of a film production company. The crew was making the documentary “Cancer: The Emperor of All Maladies,” based on the Pulitzer Prize-winning book by Siddhartha Mukherjee, MD, PhD. The six-hour film premiered on PBS in 2015. Siddiqui, 26, now a first-year medical student at Upstate, worked on the project for 15 to 20 hours a week in New York City, continuing for about a year after his 2012 graduation. “We were trying to catalog the history of cancer from the earliest recorded history, from Hammurabi and ancient prehistory, trace it down through the advent of chemotherapy, surgical procedures to remove tumors, down to the present day — a millennium of living with the disease,” he says. “My job was to look at trends in cancer all across the world, so we could break it down into key terms,” he says. Siddiqui focused on the history of chemotherapy, which from its earliest days, about a century ago, competed with the long-established cancer treatment of surgery. “Eventually, chemotherapy proponents and surgeons worked together in a clear analogue of what we have today,” he explains.

Raghib Siddiqui PHOTO BY SUSAN KEETER

Siddiqui got a master’s degree in biomedical sciences from Tufts University before coming to Upstate. He says with his penchant for carpentry and building things, he is leaning toward a surgical career, probably in pediatrics. ● Visit PBS.org to watch “Cancer: The Emperor of All Maladies” documentary. It’s also available for purchase at shoppbs.org.

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IMPROVING LIVES

Acorn Squash & Apple Soup

Nutritional information This recipe makes six servings. Each contains:

FOR A SOOTHING, COOL-WEATHER MEAL that’s easy on the mouth and the tummy, turn to squash, apples and onion. When combined into this satisfying soup, you’ll have a good source of potassium and fiber. Prep time takes about 20 minutes. Soup’s ready for serving within an hour.

Ingredients 1 medium acorn or butternut squash (1 ½ to 2 pounds) 2 tablespoons butter or margarine 1 medium yellow onion, sliced (1/2 cup) 2 medium tart cooking apples, peeled and sliced 1 teaspoon dried thyme leaves

½ teaspoon dried basil leaves 2 cans (14 ounces each) chicken broth ½ cup half and half 1 teaspoon ground nutmeg ½ teaspoon salt ¼ teaspoon white or black pepper

190 calories 7 grams fat 20 milligrams cholesterol 670 milligrams sodium 690 milligrams potassium 20 grams carbohydrates 6 grams dietary fiber 5 grams protein SOURCE: BETTY CROCKER LIVING WITH CANCER COOKBOOK

Preparation 1. Heat oven to 350 degrees. Cut squash in half; remove seeds and fibers. Place cut sides up in 13- by 9-inch pan. Pour ¼ inch water into pan. Bake uncovered about 40 minutes or until tender. Cool. Remove pulp from rind and set aside. 2. Meanwhile, in heavy 3-quart saucepan, melt butter over medium heat. Add onion; cook 2 to 3 minutes, stirring occasionally, until crisp-tender. Stir in apples, thyme and basil. Cook 2 minutes, stirring constantly. Stir in broth. Heat to boiling. Reduce heat; simmer uncovered for 30 minutes. 3. Remove 1 cup apples with slotted spoon; set aside. Place 1/3 each of the remaining apple mixture and squash in blender or food processor. Cover, blend on medium speed about 1 minute or until smooth, then pour into bowl. Continue to blend in small batches until all soup is pureed. 4. Return blended mixture and 1 cup reserved apples to saucepan. Stir in half-and-half, nutmeg, salt and pepper and cook over low heat until thoroughly heated.

Where to find advice for eating right REGISTERED DIETITIAN NUTRITIONIST Maria Erdman recommends these resources for help eating well during and after cancer treatment. She also sees patients who are referred by physicians. Reach her at 315-464-3607. l

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The National Cancer Institute makes the book “Eating Hints: Before, During and After Cancer Treatment” available free of charge by calling 800-4-CANCER or online at cancer.gov/cancertopics/coping/eatinghints

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The book “Nutrition for the Person With Cancer During Treatment” by the American Cancer Society is available by calling 800-227-2345 or online at www.cancer.org

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For more information on cancer research and foods that fight cancer, see the American Institute for Cancer Research at aicr.org or the “Eat Right to Fight Cancer” section of oncologynutrition.org

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“A Consumer’s Guide to Food Safety Risks” is available at foodinsight.org ● upstate.edu/cancer l fall 2016


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MAKING A DIFFERENCE LIVING WITH CANCER

Art from adversity Students transform radiation masks into artistic décor BY LILY GRENIS

“EVERYTHING WILL BE OK. I’LL BE IN A BETTER PLACE. I LOVE YOU.” Amina Gingold’s mother spoke these words to her while dying of colon cancer. Gingold paid tribute to her mother by embellishing these phrases with paint and flowers as a way to transform suffering into beauty. Gingold and six other Manlius Pebble Hill students in the advanced studio art class created art out of radiation masks used to treat head and neck cancer as part of Beneath the SurFACE, a project organized by the Upstate Cancer Center. Eight schools and 25 professional artists from Central New York participated in the project, which also educated the artists about these cancers. Gingold lost her mother, Naomi Chernoff, in fifth grade.

Gingold painted her mask white with tears flowing from its closed eyes. Clustered in the blue are vibrant flowers, representing beauty growing out of pain. Creating beautiful art from unimaginable ordeals was no simple task, however. Teresa Henderson, chair of the visual art and design department and class instructor, described the difficulty of doing justice to a cancer patient’s experiences through the masks. “Because it’s such a big topic and it’s such a real topic,” Henderson said, “the topic has to be treated with a level of respect, but it also needs to have the balance of the artistic voice as well.” Six MPH masks, including Gingold’s, were auctioned off at the Upstate Cancer Center in April. The auction raised more than $6,000 for the center’s head and neck cancer patient fund. Upstate also produced a documentary about the project designed to serve as an educational tool for cancer prevention. MPH students were interviewed for the film. Going forward, Henderson hopes the masks will be informative tools in the community. “Art isn’t something that just hangs on the wall,” she said. “Art is something that has the ability to engage, it has the ability to advocate, and it has the ability to bring more information and more awareness.”●

“I wanted it to be something meaningful for the cause,” said Gingold, who graduated last June. “I thought I would make an ode to her.”

This story by Lily Grenis, a student at Manlius Pebble Hill School, first appeared in her school publication, the Pebble.

Mask sculpture by Amina Gingold PHOTO BY WILLIAM MUELLER

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Non Profit Org. US Postage

PAID Permit No 110 Syracuse, NY 750 East Adams Street l Syracuse, NY 13210

UPClose

A quick way to diagnose a suspicious lump FINE NEEDLE ASPIRATION is a quick, highly accurate biopsy for diagnosing lumps in the breast or thyroid areas or lymph nodes in the neck, groin or armpit. The minimally invasive procedure is most often used to test for cancer.

16.374 1116 33.250M canfieldsk

After numbing the skin with a spray, a staffer from Upstate’s cytopathology laboratory pierces the lump with a needle — like the ones used for flu shots — then applies some suction and moves the needle inside the lump to dislodge some cells. Less than a minute later, the suction is released, the needle is withdrawn, and the cells are put on a slide and evaluated. The patient usually waits a few minutes to see whether the cell sample is sufficient or needs to be repeated. A pathology report to the patient’s health care provider is usually ready within 24 hours. The test might be conducted in a clinic or at a hospital bedside, sometimes guided by medical imaging. Complications are infrequent, and discomfort is usually minimal.● Pictured: A biopsy is reviewed while the patient waits. PHOTO BY WILLIAM MUELLER


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Please enjoy the fall issue of Cancer Care, brought to you by the Upstate Cancer Center and produced by Marketing & Communications at Upstat...

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